America’s opioid crisis has been uniquely lethal. A look around the world shows us how other nations have mitigated it much more successfully. For starters, we can say drug policy in America is killing people through failure to adapt, but there are two other affronts to the values of free people in conflict: our policy of fighting illicit drug use through the criminal justice system has created the world’s highest incarceration rate. End the jailing tomorrow and another dilemma replaces it: free people also have the right to not be slaves to the follies of another. We will still be paying for the consequences of legal substance abuse.

So, it’s over-incarceration versus moral-hazard – a question of choosing the lesser evil. This is a debate in any theology. In my religious education, the answer was: “it’s easy to choose between a good and an evil, the Christian chooses the good. It’s only when the choice is between two evils that ethical dilemmas occur. Define the circumstances, and choose the lesser of two evils.

Libertarian theology breaks down when there is no solution space to evolve a peaceful alternative. I’d like to start a drug rehab clinic, I’m qualified to administer opiates, I use them all the time, and I have treated many overdoses. If I could, I’d apply progressive dosage reduction until the addiction is diminished away. But with voluntary and adaptive solutions illegal, we have to accept a lesser evil.

That would be Heroin Assisted Treatment (HAT), which is being implemented everywhere in the developed world. HAT works first in mitigating death and damage by making overdoses rare, by offering clinically controlled doses under clinical supervision.

HAT costs pennies to the dollar: I’ve resuscitated overdoses who were left with anoxic brain injuries that will cost you all hundreds of thousands of dollars a year in care and rehabilitation. That pays for a lot of HAT.

HAT also creates an evolution to counter the illegal drug markets: an opioid adventurer has a 1 in 4 chance of becoming an addict. Once a heroin addict, the prospect of supporting jo,se;f (and his addiction, at least a hundred dollars a day) through the normal 9-5 becomes ridiculously remote. Add in the problem of the criminal records co-morbid with addiction, and it’s clear why only outlier entertainers manage a legit life with addiction (and not for long).

Graze on some drug addiction web forum sites, and marvel at the width and breadth of the capers and scams they innovate, that you and I also pay for, to make their “nut” (My favorite: getting themselves on CPAP to manage their respiratory depression). This is not at all hard to figure out. As one contributor put it: “if you want to know how addiction feels, submerge yourself in a bathtub until you battle for air, then imagine what you’d do to take that breath. Try to deter that.” Mitigate this black market and America most likely would have crime commensurate with the rest of the developed world.

Addicts are out making money for their living and their nut of addiction in the black markets. The one addict in four pays for his one by feeding other “ones” and dabbling with “threes.” Addicts stay addicts by feeding addicts and creating other addicts. Get that one off the street and get him his heroin, the other threes are never exposed and the other ones find it harder to stay addicted.

A not-insignificant benefit of HAT is the criminal undergrounds have their revenue streams dried up, shrinking the most violent underworlds in history. Every gunshot wound in that drug war costs the taxpayers $100,000 (that’s a lot of HAT). I reckon my HAT clinic can be run at the cost of three gunshot wounds. I could treat dozens of addicts every day for that.

Another benefit would be the addict can be phased into rehab, or into less disruptive drugs like Methadone. They would then be functional enough to work and contribute. Everyone’s slavery would be diluted with more slaves to pay less cost.

If you object to writing a blank check for this kind of treatment welfare, realize you have created the dilemma by writing a blank check for incarceration. Consider the cultural evil of what it says about us, that we’ve written those with so little complaint, versus how we chisel, scrape and parse over paying for the treatments that would mitigate it.

Moral hazard is the lesser evil in this case: It mitigates slavery by stealing millions rather than billions. It altogether eliminates our over-incarceration hypocrisy. It will mitigate our outlier violence. America’s all-out drug war is as much an outlier as our terrible outcomes, and those facts are related. It will mitigate the disease of addiction, and allow greater latitude for recovery, while killing far fewer addicts .

Maybe poor junkies can then be just like all other poor folk who need help paying for their medications. There are no Mexican drug cartels involved in managing low income hypertension.

Eugene Darden Nicholas

About Eugene Darden Nicholas

Eugene Darden (Ed) Nicholas is from Flushing Queens, where he grew up sheltered from the hard world, learning the true things after graduating college and becoming a paramedic in Harlem. School continues to inform and entertain in all its true, Shakespearean glory. It's a lot of fun, really. In that career, dozens of people walk the earth now who would not be otherwise. (The number depends on how literally or figuratively you choose to add). He added a beloved wife to his little family, which is healthy. He is also well blessed in friends and colleagues.


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